Understanding IMSI Treatment
Learn from our experts and get inspired by real patient journeys
Keyhole Surgery Diagram
A clean 3-port keyhole setup removes the biggest fear most patients have about surgery. There is no large abdominal cut. The camera enters through the navel, the working instruments through two lower ports, and everything is seen on the HD theatre monitor in real time.
This is the question that brings most patients to Dr. Shah’s surgical consultation: “My ultrasound is normal, my hormones are normal, my husband’s semen analysis is normal – so why am I not pregnant?” The answer is almost always that there is a structural problem inside the pelvis that standard investigations simply cannot detect.
Found in 30-50% of unexplained infertility cases at laparoscopy.
Found in 15-40% – often from prior infection, prior surgery, or ruptured appendix.
Partial or complete blockage, fimbrial damage, or early hydrosalpinx formation in 10-30%.




Laparoscopy at Wellspring is never just a “look inside.” Dr. Pranay Shah follows a fundamental principle: you do not put a patient under general anaesthesia for information alone. If something correctable is found, it is corrected in the same procedure – same anaesthesia, same incisions, same recovery. This is the single biggest advantage of operative laparoscopy over diagnostic-only scoping.
The word “surgery” understandably causes anxiety. Understanding exactly what happens – in plain language – transforms this from something frightening to something logical and manageable. Here is every step of a diagnostic and operative laparoscopy at Wellspring IVF:
General anaesthesia is administered by a consultant anaesthetist. You are completely asleep and feel nothing throughout the procedure. The entire process is monitored with pulse oximetry, ECG, and blood pressure tracking.
A small needle (Veress needle) creates a tiny entry point at or near the navel. CO2 gas is gently introduced into the abdominal cavity. This creates space between the abdominal wall and the internal organs – giving Dr. Shah a clear, unobstructed field of view.
2-3 small incisions (each 5-10mm – smaller than a centimetre) are made on the abdomen. Metal or plastic trocars (hollow tubes) are inserted through these incisions. These are the “ports” through which all instruments travel. There is no large abdominal cut.
A slim laparoscope (a camera with fibre-optic light) is inserted through the central port. Dr. Shah performs a complete 360 degree systematic survey of all pelvic organs – uterus, both ovaries, both fallopian tubes, the pouch of Douglas (behind the uterus), the bowel surface, the bladder, and the peritoneum. This is the diagnostic phase. Everything is displayed in high definition on the operating theatre monitor.
If any pathology is found – endometriosis implants, fibroids, adhesions, blocked tubes, ovarian cysts, or PCOS follicles – Dr. Shah treats it immediately without a second procedure. Specialised instruments are inserted through the other ports. Energy devices (harmonic scalpel, bipolar diathermy) allow precise cutting, ablation, or coagulation with minimal blood loss.
Blue methylene dye is injected through the uterine cervix during the procedure. Dr. Shah directly observes whether the dye flows freely out of each fallopian tube, spills freely into the pelvis, or is obstructed. This is the gold standard of tubal patency assessment – far more accurate than an X-ray HSG.
All instruments are removed. The CO2 gas is released. The abdomen returns to normal. The tiny port sites are closed with 1-2 absorbable sutures or skin glue – no stitches to remove.
You wake up in the recovery room. Most patients are fully alert within 1-2 hours. At Wellspring, diagnostic laparoscopy is performed as a day-care procedure – the majority of patients are discharged the same day or with one overnight stay.
Dr. Pranay Shah on What Patients Fear Most: “The most common thing I hear is: ‘Doctor, I am scared of surgery.’ And my answer is always the same: what you are imagining is not what this is. You are imagining a large abdominal cut, weeks in hospital, and months of recovery. Laparoscopy is three incisions – each smaller than your fingernail. You arrive in the morning, the procedure takes 1 to 2 hours, and most of my patients go home the same evening. The fear of the procedure should never stand between you and the answer to why you are not conceiving.”
After 5 years of marriage and visiting many places, when we came here, we decided on the right guidance here that we will get the ivf procedure done from here, today we have 10 days of treatment. Due to the convenience, arrangement and facility o...
My experience with wellspring hospital is very good .their staff is very supportive. Dr. Pranay is very good and professional.100% transparency at every stage. No last minute surprises.Once again thank you so much to the all team. Highlly recomme...
Wellspring IVF & women hospital is one of the best IVF center in India where me like other infertile Indian and foreigner couples fulfill their dreams of having a healthy baby.Dr Pranay Shah has deep knowledge and skill in his work with positive ...
Such a nice experience at well spring. And we get A childhope from this well spring hospital. Thanks a lot all members of hospital and specially to Dr. Pranay Shah sir
This is one of the best ivf clinic in Ahemdabad, Dr.Pranay shah and his team are highly professional and knowledgeable, and his staff members are too good and supportive. Dr. Pranay shah is result oriented and confident, and gives right instructi...
We were facing some difficulties related pregnancy and we got reference of Wellspring Hospital. We thank God that we found such a talented and knowledgeable Dr. Pranay Sir. The most thing we like about him is the way of treatment he follows. I str...
I've been blessed with two daughters by the treatment given by Dr. Pranay Shah the services given to me were comforting and caring.
This is one of the best hospital in ivf treatment with highest possibility of success, best supportive doctor and staff, thanks and recommended all to visit once
No words are enough to express my gratitude . Thank you for making our dream comes true. You are extraordinary doctor as well as extraordinary human being also.Again thank you so much Dr.Pranay Shah and your team. Best ever doctor I have meet in ...
Great experience with great doctor and very supportive after care facilities. Dr. Shah was not only helpful with numerous questions that we asked for around 6 months before we started the treatment but is also helping us now. He has been very help...
We were looking for a good fertility center we came across some good reviews of Wellspring Spring Ivf Hospital. We decided and visited the hospital and with in no time the process was completed and in first attempt only the result was positive?. ...
It has been one of the best choices that I could have made. Since researching Wellspring on Google till now the end of complete IVF cycle it has been a wonderful experience. I could have gone to biggies referential IVF Centres but I am sure experi...
We had been very desperate to have a child. Visited many IVF centers in India for treatment. But did not get any positive result. Visited the Best IVF Center in Ahmedabad Wellspring IVF and Women's hospital after seeing good reviews. Happy to sa...
Wellspring IVF & Women's Hospital is best IVF Center in Ahmedabad. Best thing, we got positive result in Fist IVF Cycle. Second best thing, Doctor has told us exact amount of Cost of each IVF Cycle before start of treatment so there would be no en...
Me and my husband are very glad we chose to come here for treatment. I would highly recommend Dr. Shah and his team at the Wellspring IVF and Women's hospital to anyone wanting to reach their dream of becoming parents. His medical knowledge and p...
No words are enough to express my gratitude . Thank you for making our dream comes true. You are extraordinary doctor as well as extraordinary human being also.Again thank you so much Dr.Pranay Shah and your team.
Excellent IVF Center. Friendly nature all staff & Doctor. Excellent Treatment for the Doctor. Thanks Wellspring IVF Fullfil our Dreams.
What to say about dr pranay sir Very good human being along with very good doctor Always showers positivity on us Solves every small small queries with open heart and big smile Approachable 24*7 I will suggest everyone to consult at least once if ...
hhhhh
For fertility patients, the choice between laparoscopic and open surgery is not simply a preference – it has direct consequences for recovery speed, adhesion formation, and how quickly you can attempt conception or IVF. Here is the complete comparison:
| Factor | Laparoscopy (Keyhole) | Open Surgery (Laparotomy) |
|---|---|---|
| Incision size | 3 small cuts – 5 to 10mm each (less than 1cm) | One large abdominal cut – 10 to 20cm |
| Scar visibility | Nearly invisible – fades within months | Prominent, permanent abdominal scar |
| Hospital stay | Day care or 1 night (majority of cases) | 3 to 5 days minimum |
| Return to normal activity | 5 to 7 days for desk work; 2 weeks full recovery | 4 to 6 weeks recovery |
| Post-operative pain | Mild – shoulder/upper abdomen discomfort (CO2 gas) for 1-2 days | Significant wound pain for 1-2 weeks |
| Blood loss | Minimal – controlled precision instruments | Higher – larger operative field |
| Infection risk | Very low – small entry points | Higher – larger wound surface |
| Pelvic adhesion risk post-op | Low – less tissue trauma, faster healing | Higher – large wound creates adhesion risk |
| Fertility recovery | Faster – conception attempts can begin within 1-2 cycles | Delayed – longer tissue healing required |
| Magnification | 10-20x magnification on HD monitor – sees what the naked eye cannot | Direct visual field – no magnification |
Why Adhesion Prevention Matters in Fertility Surgery Every surgery creates some degree of healing response. In the pelvis, aggressive tissue handling, large incisions, and prolonged exposure of raw surfaces can cause new scar tissue (adhesions) to form during healing – the very problem surgery was meant to address. Laparoscopy, by its minimally invasive nature, causes significantly less peritoneal trauma than open surgery. Combined with precise surgical technique – thorough irrigation, careful haemostasis, and anti-adhesion agents where appropriate – Dr. Shah minimises the risk of de novo adhesion formation after the procedure.
Dr. Shah performs operative laparoscopy for the following fertility-affecting conditions. Each condition card explains what is found during the diagnostic survey and what is corrected during the operative phase of the same procedure.
The laparoscope does not guess. It shows the uterus, ovaries, tubes, pouch of Douglas, bowel surface, bladder, peritoneum, adhesions, implants, endometriotic deposits, hydrosalpinx, and pelvic organ mobility directly on the monitor. That is why the findings change treatment.
The most commonly missed cause of unexplained infertility – invisible on routine ultrasound in its early stages.
Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus – on the ovaries, fallopian tubes, the back of the uterus (pouch of Douglas), the bladder, bowel surface, and the peritoneum. Mild endometriosis (Stage I and II) has no ultrasound signature whatsoever – it appears as microscopic deposits, fine powder-burn spots, or clear implants on the peritoneal surface. Dr. Shah identifies Stage I-IV endometriosis, including deep infiltrating endometriosis, retroversion of the uterus, and chocolate cysts (endometriomas) of the ovary.
Excision of endometriotic implants from the peritoneum (preferred over ablation – removes the full lesion), endometrioma (chocolate cyst) cystectomy with maximum ovarian reserve preservation, lysis of peri-ovarian and peri-tubal adhesions, restoration of normal pelvic anatomy, and peritoneal washing to remove inflammatory fluid that impairs sperm function and embryo implantation.
For medicine-resistant PCOD where clomiphene and gonadotropins have failed to trigger ovulation.
In PCOD, the ovaries contain multiple small follicles that fail to mature and rupture – causing chronic ovulation failure. Most patients with PCOD ovulate with oral medication or low-dose injectable gonadotropins. But in 15-20% of PCOD patients, medication resistance means months of failed cycles. Laparoscopy in this group allows Dr. Shah to directly assess both ovaries – their size, the density of follicles, the quality of the ovarian cortex – and confirm the PCOD morphology at direct visual inspection.
Laparoscopic Ovarian Drilling (LOD): a diathermy needle or laser creates 4-8 small punctures (1-2mm deep) in the ovarian cortex of each ovary. Drilling reduces the androgen-producing stroma and corrects the LH:FSH hormonal imbalance – restoring a natural ovulatory cycle in 70-80% of previously anovulatory patients. It avoids OHSS and multiple pregnancy risk associated with gonadotropins.
Surgical removal of fibroids that distort the uterine cavity or impair implantation.
Not all fibroids impair fertility. The critical distinction is location. Submucosal fibroids (inside the cavity) and large intramural fibroids (within the uterine wall, >4-5cm) directly impair implantation and increase miscarriage risk. Subserosal fibroids (on the outer surface) rarely affect fertility unless very large. Laparoscopy allows Dr. Shah to assess all fibroids – their exact position relative to the endometrial cavity, vascularity, and number – with a level of detail unavailable on ultrasound alone.
Laparoscopic myomectomy removes fibroids through keyhole incisions while preserving the uterus. The fibroid is enucleated from the uterine wall and extracted through the ports. The uterus is repaired in layers with absorbable sutures under magnification. Unlike open myomectomy, there is less blood loss, less adhesion formation, faster healing, and earlier return to fertility. Very large fibroids (>10-12cm) or multiple fibroids (>5) may require open myomectomy, and Dr. Shah advises honestly on the right approach. Post-myomectomy waiting: 3-6 months before IVF or conception attempts.
Including the mandatory salpingectomy before IVF for hydrosalpinx patients.
Fallopian tube disease is assessed during the diagnostic phase using chromopertubation – blue dye injected through the cervix while Dr. Shah directly watches both tubes under the laparoscope. A normal tube shows free spill of dye from the fimbriated end into the pelvis. A blocked tube shows no spill. A hydrosalpinx (fluid-filled tube) is visible as a swollen, sausage-shaped structure – and is a fertility emergency because the toxic fluid inside leaks back into the uterus and actively destroys embryos during IVF.
Tubal cannulation for proximal blockages, fimbrioplasty / fimbriolysis for minor fimbrial adhesions, salpingectomy (tube removal) for hydrosalpinx, and adhesiolysis around tubes trapped by endometriosis or post-infection scar tissue. Salpingectomy for hydrosalpinx is mandatory before IVF because the toxic fluid reduces IVF success rates by 50%.
Scar tissue that traps organs, distorts tubal anatomy, and blocks the path of sperm to egg.
Pelvic adhesions are bands of scar tissue that form between organs – ovary to tube, tube to uterus, uterus to bowel, ovary to pelvic wall. They are completely invisible on ultrasound. Their causes include prior pelvic infection (PID), prior abdominal or pelvic surgery, ruptured appendix, prior laparoscopy with poor technique, and severe endometriosis. Adhesions fix organs in abnormal positions, prevent the fallopian tube from picking up the egg after ovulation, and can kink or occlude the tube entirely.
Adhesiolysis uses scissors, harmonic scalpel, or laser energy to cut through adhesion bands under direct magnified vision. Organ mobility is restored. Fine peritoneal adhesions overlying the tube are removed to restore the tube’s natural sweeping function. Anti-adhesion agents (Interceed, Seprafilm) may be applied to raw surfaces to reduce adhesion reformation. After adhesiolysis, natural conception attempts in the first 3-6 months offer the best spontaneous pregnancy window.
Clinical honesty is the foundation of every surgical recommendation Dr. Shah makes. Laparoscopy is not a universal first-line investigation – it is a surgical procedure under general anaesthesia, and it is recommended only when the clinical picture justifies it.
Dr. Shah’s guiding principle: “I will not perform surgery for a problem I am not certain exists, and I will not withhold surgery for a problem that is preventing pregnancy. Every recommendation is explained with clinical reasoning – not protocol.”
| Clinical Situation | Without Laparoscopy First | With Laparoscopy First | Dr. Shah’s Recommendation |
|---|---|---|---|
| Hydrosalpinx present | IVF success rate reduced by ~50% – toxic fluid contaminates uterine environment at embryo transfer | Salpingectomy removes the toxic source. IVF success restored to expected rates for age/embryo quality | Laparoscopy + salpingectomy MANDATORY before IVF. Non-negotiable. |
| Stage III-IV Endometriosis | Heavy peritoneal inflammation, ovarian damage, distorted anatomy – all impair egg quality and implantation | Surgical clearance improves egg retrieval, reduces inflammation, restores anatomy | Strongly recommended before IVF – particularly for large endometriomas |
| Stage I-II (Mild) Endometriosis | Moderate evidence for benefit of surgical treatment before IVF – clinical debate exists | Excision removes inflammatory load and may improve implantation | Case-by-case – depends on patient age, embryo reserve, and prior IVF history |
| Submucous fibroid distorting cavity | Fibroid directly competes with embryo for implantation space – failed transfer likely | Myomectomy removes the distortion. Uterine cavity normalised before embryo transfer | Recommended – hysteroscopic or laparoscopic depending on fibroid type and size |
| Pelvic adhesions suspected | Tubes may be blocked/kinked – failed egg pickup. Anti-adhesion environment hostile to IVF | Adhesiolysis frees organs, restores normal pelvic environment | Recommended when suspicion is high – particularly post-infection or post-surgical |
| Normal anatomy, first IVF attempt | Proceeding directly to IVF is standard | No benefit from exploratory laparoscopy before first attempt with no clinical indication | NOT recommended – first IVF attempt with no findings should proceed without surgery |
For patients with bilateral tube disease, older patients (>35), low ovarian reserve, or male factor alongside corrected pelvic pathology. Read the IVF Treatment Hub.
For patients with patent tubes, good ovarian reserve, and mild male factor – IUI immediately post-surgery has high natural conception rates. Read more.
For patients under 35 with single-factor disease (mild endometriosis, adhesiolysis, PCOD drilling): 3-6 months of natural attempts before ART is recommended.
Frequently combined with laparoscopy on the same day to assess the uterine cavity simultaneously – one anaesthetic, complete pelvic + uterine evaluation. Read more.
Clinical honesty is the foundation of every surgical recommendation Dr. Shah makes. Laparoscopy is not a universal first-line investigation – it is a surgical procedure under general anaesthesia, and it is recommended only when the clinical picture justifies it.
| Timeframe | What You Experience | Activity Level |
|---|---|---|
| Day of procedure | Awake within 1-2 hours. Mild abdominal discomfort. Shoulder or upper abdominal pain (CO2 gas under the diaphragm) – common, resolves in 24-48 hours. Nausea from anaesthesia in some patients. | Resting. Accompanied discharge same evening for most patients. |
| Day 1-2 | Bloating and mild incision site tenderness. CO2 shoulder pain peaks and then resolves. Light activity at home. | Walking around the house. No driving. No heavy lifting. |
| Day 3-5 | Most patients feel significantly better. Incision soreness minimal – incisions are healing. Energy returning. | Light housework. Can sit comfortably and work from home. |
| Day 5-7 | Return to desk work / office for most patients. | Normal desk activity. Avoid heavy physical exertion. |
| Day 10-14 | Full physical recovery in the majority of cases for diagnostic laparoscopy. Operative cases with myomectomy or extensive adhesiolysis: 2-3 weeks. | Normal activity including exercise. |
| 3-6 months post-op | Uterine healing complete (myomectomy cases). Ovulation cycles re-established (ovarian drilling cases). Pelvic environment restored. | Active fertility attempts – natural, IUI, or IVF as planned with Dr. Shah. |
When to Contact Wellspring After Laparoscopy Serious complications after laparoscopy are rare – occurring in less than 1% of procedures in experienced hands. However, contact Dr. Shah’s team immediately if you experience: fever above 38°C (100.4°F) after the first 24 hours, increasing abdominal pain that is worsening not improving after Day 2, shoulder pain that is worsening after Day 3 (normal CO2 shoulder pain improves, not worsens), heavy vaginal bleeding beyond normal light spotting, difficulty passing urine or significant abdominal bloating, or any discharge or redness from the incision sites. Wellspring IVF post-surgery helpline: 9099946050.
Laparoscopy is performed under general anaesthesia – you are completely asleep and feel nothing during the procedure. After surgery, the most common discomfort is not from the incisions (which are tiny) but from residual CO2 gas under the diaphragm causing referred pain to the shoulder and upper abdomen. This is a pressure sensation, not a wound pain – it resolves completely within 24-48 hours as the gas is absorbed. Most patients rate their post-laparoscopy pain as 2-4 out of 10 and manage it well with standard painkiller tablets. The anxiety before the procedure is almost always greater than the discomfort after it.
Diagnostic laparoscopy means inserting the camera to assess and identify any pathology. Operative laparoscopy means the surgeon also treats the identified pathology during the same procedure using additional instruments through the other ports. At Wellspring, Dr. Shah always performs both functions together – you are not woken up with a “we found something, we need to schedule a second procedure” outcome. If it is findable and fixable, it is fixed in the same sitting under the same anaesthesia.
A pure diagnostic laparoscopy (look and dye test only) takes approximately 30-45 minutes from first incision to skin closure. When operative procedures are performed, the total time depends on the findings: endometriosis excision adds 30-60 minutes, ovarian drilling 15-20 minutes, adhesiolysis 30-60 minutes depending on severity, and laparoscopic myomectomy 60-120 minutes for moderate-sized fibroids. Dr. Shah discusses the anticipated duration with you during your pre-operative consultation based on your specific findings and planned procedures.
Standard diagnostic laparoscopy does not affect ovarian reserve. Ovarian drilling for PCOD causes a modest, temporary reduction in AMH (anti-Mullerian hormone) in some patients – this typically recovers within 3-6 months. The most important consideration is endometrioma cystectomy: removing a chocolate cyst unavoidably removes some healthy ovarian tissue along with the cyst wall. Dr. Shah uses the “stripping technique” to minimise normal ovarian tissue loss during endometrioma removal. For patients with already-reduced ovarian reserve (low AMH), the risk-benefit of endometrioma surgery versus proceeding directly to IVF is discussed in detail before any surgical recommendation is made.
For standard diagnostic laparoscopy with or without minor operative procedures (ovarian drilling, mild adhesiolysis, tubal dye test), the procedure is performed as a day-care case at Wellspring – you arrive in the morning, the procedure is completed, and you are discharged the same evening with an accompanying person. For more extensive operative procedures – laparoscopic myomectomy, severe endometriosis excision, or significant adhesiolysis – one overnight stay may be recommended for monitoring. Dr. Shah discusses expected hospital stay during your pre-operative consultation.
Yes – absolutely, and this is non-negotiable based on current evidence. A systematic review of published studies (Cochrane, ESHRE) shows that the presence of a hydrosalpinx reduces IVF live birth rates by approximately 50% compared to patients without hydrosalpinx. The mechanism is well-established: the toxic fluid inside a hydrosalpinx periodically refluxes into the uterine cavity, creating an embryo-hostile environment at the time of transfer. Salpingectomy (surgical removal of the damaged tube) before IVF consistently doubles live birth rates in affected patients. This is not a commercial surgical recommendation – it is a clinical evidence-based requirement. The tube removed was already non-functional for natural conception. Read more on Blocked Fallopian Tubes.
The cost of laparoscopy depends on the type and complexity of the procedure – a diagnostic laparoscopy with dye test is priced differently from an operative procedure involving myomectomy or severe endometriosis excision. At Wellspring, Dr. Shah provides a complete, itemised cost estimate during your pre-operative consultation, based on the procedure planned and the facilities required. There are no hidden charges added post-operatively for findings that were discussed beforehand. For current pricing, call 9099946050.